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Department of the Army Pamphlet 40-502 Medical Readiness Procedures (27 June 2019)

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Chapter 3

Individual Medical Readiness - Key Elements, Standards, Categories, and Goals

3–1. Overview

Maintaining their readiness is an individual Soldier’s responsibility. Per DODI 1332.45, Soldiers, commanders and healthcare providers must immediately correct all IMR deficits to ensure Service members are medically ready to deploy. IMR is the foundation of a unit’s Armywide medical readiness and deployability determinations. …

3–2. Individual medical readiness

a. General. DODI 6025.19 establishes IMR as a Soldier’s responsibility. There are six measurable elements of IMR for all Services. Senior leaders report IMR data to the DOD. The Army reports IMR as:

  • (1) PHA currency (required by DOD).
  • (2) DL conditions (required by DOD).

Comentario: DL significa despliegue limitante

  • (3) DRC (required by DOD).
  • (4) Immunization status (required by DOD).
  • (5) HIV test and DNA specimen (required by DOD).
  • (6) Individual medical equipment (required by DOD).
  • (7) Hearing readiness (Army-specific requirement).
  • (8) Vision readiness (Army-specific requirement).…

3–4. Commander deployability determinations

a. In making deployability determinations, unit commanders should consider the Soldier’s duties, type of mission, and geographic conditions or concerns. Execution and support for medical readiness both improve when there is close collaboration with supporting (unit or MTF) health care providers. Army leaders needs accurate deployment statuses and readiness assessments to train, man, and equip the force.…

d. Commanders ensure Soldiers are medically ready prior to deployment. During a deployment, the commander assesses changes in a Soldier’s deployment status, whether from injuries, worsening of known medical conditions, or the diagnosis of new medical conditions.…

Chapter 4

Physical Profiles

4–1. General

a. This chapter describes processes for communicating functional abilities, medical instructions and recovery time estimates to commanders, for accurate readiness and duty assignment…. In accordance with AR 40–502, unit commanders may not override duty limitations or instructions on DA Form 3349.

b. Determining individual assignments or duties is a commander’s decision. Limitations such as “no field duty,” or “no overseas duty,” are not proper medical recommendations. Administratively, Soldiers in certain deployment-limiting categories will have these constraints (such as pregnant Soldiers and Soldiers pending medical and administrative boarding action). Profiling providers must provide specific information on the Soldier’s functional limitations, capabilities, and a description of what the Soldier “can do” to enable assignment or duty determination by the nonmedical commander or U.S. Army Human Resources Command. The profiling provider ensures that complete and accurate administrative information is annotated on the DA Form 3349.

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c. The commander or personnel management officer determines proper assignment and duty, based on knowledge of the Soldier’s profile, assignment limitations, and the duties of the grade and MOS.

d. The commander has the final decision on the deployment of Soldiers in his or her unit. When health care providers and commanders disagree on the medical readiness status of a Soldier, the decision will be raised to the first O–6 in the Soldier's chain of command, who makes the final decision whether to deploy the Soldier in consultation with the appropriate medical officer. Deployment waivers may be required for certain areas of operation.

4–3.Physical profile serial system

a. The basis for the physical profile serial system is the function of body systems and their relation to military duties. Profiling providers will use permanent profiles to describe and rate the function of the extremities, sensory organs, physical capacity, and mental health according to the system described in the following paragraphs….

b. The permanent physical profile has six functional areas “P–U–L–H–E–S” with four numerical designations used to reflect different levels of functional capacity, described in the following paragraph and table 4–2. The determination of the numerical designation 1, 2, 3, or 4 evaluates the functional capacity of a particular organ or system of the body.

c. The functional areas for consideration are:

  • (1) P – Physical capacity or stamina. This is general physical capacity and normally includes conditions of the heart; respiratory system; gastrointestinal system and genitourinary system; nervous system; allergic, endocrine, metabolic, and nutritional diseases; diseases of the blood and blood-forming tissues; oral maxillofacial conditions; dental conditions; dis-eases of the breast, and other organic defects and diseases that do not fall under other specific factors of the system.
  • (2) U – Upper extremities. This is the function and/or diseases of hands, arms, shoulder girdle, and upper spine (cervical and thoracic); as they affect strength, range of motion (ROM), and general efficiency.
  • (3) L– Lower extremities. This is the function and/or diseases of feet, legs, pelvic girdle, lower back musculature, and lower spine (lumbar and sacral) as they affect strength, ROM, and general efficiency.
  • (4) H – Hearing and ears. This is auditory performance.
  • (5) E – Eyes. This is visual acuity and diseases and defects of the eye.
  • (6) S – Psychiatric. This is personality, emotional stability, and psychiatric diseases.

d. There are four numerical designations to describe a Soldier’s functional capacity, in each of the six functional areas of the physical profile serial system, applied to the permanent profiles. Guidance for assigning numerical designators is in table 4–2. Soldiers with a numerical designator of 3 or 4 are non-deployable until they have completed the medical or administrative board process described in AR 635–40. The profile serial and physical category codes described in para 4–5 support and document progress through the medical or administrative board processes.

e. All profiles will describe the Soldier’s functional limitations whether the condition is just presenting or has a thorough evaluation and has reached the Medical Retention Determination Point (MRDP). The MRDP is reached if a medical condition which has been temporarily profiled has stabilized or cannot be stabilized in a reasonable period of time for up to twelve months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (section 4 of DA Form 3349 and passing one aerobic AFPT event) and perform the duties required of his or her MOS, grade, or rank. If after reaching MRDP, and transitioning to a permanent profile, the Soldier does not meet the medical retention standards listed in AR 40–501, then the numerical designator must be a 3 or a 4. Any persistent deployment-limiting condition requires inherently significant duty limitation and indicates a numerical designator of 3 or 4….

  • (1) An individual having a numerical designation of “1” describes a high level of medical fitness, deployable.
  • (2) A physical profile designator of “2” under any factors indicates some medical condition or physical defect that requires some minor functional or activity limitations, deployable. (Note, a Soldier may meet medical retention standards but require a permanent 3, thus, requiring referral to MAR2 in accordance with AR 635–40).
  • (3) A profile containing one or more numerical designators of “3” describes one or more medical conditions or physical defects with significant functional or activity limitations and warrant processing through a MAR2 or DES process.
  • (4) A profile containing one or more numerical designators of “4” describes one or more medical conditions or physical defects with severe limitations of military duty performance, requires a DES board evaluation….

4–4.Temporary vs. permanent profiles

There are many electronic requirements for recording profiles. As designated in AR 40–502, profiling provider must complete all profiles for medical conditions lasting greater than 3 days, both temporary and permanent, in e-Profile. The DA Form 689 (Individual Sick Slip) may be used only once for a medical condition limited to acute, minor, self-limited illnesses requiring only 1 to a maximum of 7 days of recovery. DA Form 689 may also be used to write out medical instructions for Service members from other Services, to communicate back to other commanders. Any residual duty limitations and all conditions with functional limitations clinically expected to extend beyond 7 days must be recorded on a temporary profile in accordance with AR 40–502….Temporary profiles are not associated with a PULHES or the physical function capacity; rather they are assessed by duration only….

c. Temporary profiles. Indications for a temporary profile are conditions with limitations that will improve over time. Correction or treatment of temporary conditions is medically advisable, and should usually result in a higher level of function and employment. Profiling providers manage Soldiers receiving medical or surgical care, recovering from illness, injury, or surgery by designating a temporary condition on the Soldier’s DA Form 3349. The addition of the limitations to any previously existing temporary or permanent limitations in the e-Profile system will provide the commander a single source for the Soldier’s medical instructions and duty limitations.

  • (1) Duration: The profiling provider will write the profile for the entire length of the expected recovery up to 90 days (except as directed in paras 4–8d (tuberculosis) and 4–9 (pregnancy)). The profiling provider will extend and modify the profile for the temporary condition, to communicate with the command, until the Soldier reaches the point in their evaluation, recovery, or rehabilitation where they have returned to full duty or the profiling provider determines that the Soldier has achieved the MRDP. MRDP may occur before the 12-month administrative timeline if the condition is stable and no further functional progress is expected. At MRDP, the profiling provider will transition any remaining duty limitations to a permanent profile. All permanent profiles require two profiling provider signatures. The second signature will need to be a physician, or for profiles within their area of expertise, an audiologist or podiatrist are second signature authorities for profiles without deployment limitations. If the profile has deployment limitations, either a 3 or 4 in the PULHES or a deployment-limiting physical-category code, the second signature must be an approval authority. The maximum duration of temporary profiles is 12 months for the same medical condition without an exception, as described in paragraph 4–4c(4)below. At 12 months, the Soldier is administratively defined to have reached MRDP. …
  • (2) Temporary profiles exceeding 6 months’ duration, for the same medical condition, will be referred to a physician or medical specialist if clinically indicated, for that medical condition, or as required by policy. Specific conditions in AR 40–501 require specialty evaluation to determine if the Soldier meets retention standards. These referrals ensure the optimal care and support to help the Soldier return to duty, or ensure documentation of the injury or illness that supports the medical or administrative board process. Reviewing physicians or specialty health care providers will consider one of the following actions:
  • (a) Continuation of a temporary profile, for the same medical condition or injury, up to a maximum of 12 months from the initial profile start date;
  • (b) If the condition has reached MRDP, transition to a permanent profile;
  • (c) Determination of whether the Soldier meets the medical fitness standards for retention in accordance with AR 40–501 and, if not, refer to the DES. Once MRDP is met for one condition which does not meet retention standards, referral into the DES must commence regardless of the status of other co-existing conditions. …
  • (3) Prolonged Soldier review: There are higher authority reviews for profiles lasting over 120 days. Profiles over 120 days in duration will be reviewed by operational profile review boards, above company level, every month….
  • (4) Temporary profiles for conditions with duty limitations beyond 12 months are usually converted to permanent pro-files. For all Soldiers, the application of the second signature for a permanent profile that does not meet retention standards initiates the requirement for DES or appropriate processing….

e. Permanent profiles. Soldiers whose condition(s) have reached MRDP will receive a permanent profile…. Some diagnoses do not meet retention standards by definition and will be referred to DES upon diagnosis, in accordance with AR 40–501….

  • (3) Medical and administrative processes once a Soldier reaches MRDP and does not meet medical retention standards.
  • (a) Duty related processes through one of the three forms of DES: legacy DES, IDES, or expedited DES.
  • (b) Non-duty related physical evaluation board (ND–PEB) processing is for the reserve COMPOs only.
  • Comentario: COMPO significa componentes.

Soldiers who do not meet retention standards due to a non-duty related condition may request non-duty processing to determine if they may be retained and continue to serve.

  • (c) Administrative processing for Reserve COMPO Soldiers with non-duty related conditions proceeds when the Sol-dier does not request a ND–PEB.
  • (4) Medical and administrative processes once a Soldier reaches MRDP and meets medical retention standards.
  • (a) Transition to a permanent profile describing the permanent duty limitations….
  • (b) The MAR2 is an administrative process to evaluate the Soldier’s ability to serve in their MOS. Outcomes from the MAR2 are to retain the Soldier in their MOS, reclassify them to another MOS, or refer the Soldier for DES processing in accordance with AR 635–40.

4–5.Physical category codes

The physical category codes indicate limitations in personnel and administrative matters and are used in numerous Army systems. The current physical category codes described in tables 4–3 and 4–4 describe a history of an accession waiver, assignment, and deployment limitations, or the completion of medical board or administrative processing. Previously there were medically descriptive codes, but in accordance with AR 40–502, these are rescinded, and the profiling provider will describe these limitations in plain language on the profile to inform the commander’s duty assignments and deployment determinations….

Code F No assignment or deployment to OCONUS areas where definitive medical care for the Soldier’s medical condition is not available

Code V This code identifies a Soldier with deployment restrictions to certain areas

Code X This Soldier is allowed to continue in the military service with a disease, injury, or medical defect that is below medical reten-tion standards, pursuant to a waiver of an unfit finding and con-tinued on active duty or in active reserve status under AR 635–40.

Code S Soldier has been determined to meet medical retention standards of chapter 3 by a Medical Evaluation Board (MEB)

Code T Waiver granted for a disqualifying medical condition, or standard, for initial enlistment or appointment. The disquali-fying medical condition, or standard, for which a waiver was granted will be documented in the Soldier’s accession medical examination

Code W This Soldier has a permanent 3 or 4 profile that has been evaluated by a MAR2 with a recommendation to retain or reclassify and return to duty.

Code Y This Soldier has been found fit for duty through the disability evaluation system (DES) (not entitled to separation or retirement because of physical disability) after complete processing under AR 635–40….